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Can Good Doctors Be Bad for Your Health?

nytimes.com

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Re: Can Good Doctors Be Bad for Your Health?

#31

Post by FireBeyond »

iheartmemcache wrote: post #23
jpmattia wrote: post #7

> Despite often repeating the mantra “First, do no harm,” doctors have difficulty with doing less — even nothing. We find it hard to refrain from trying another drug, blood test, imaging study or surgery. It's disappointing that the conflict-of-interest is not better recognized. Asking a surgeon if you need surgery? Do you really expect a person under a pile of medical-school debt to give you an unbiased answer?

Most medical doctors in the US aren't paid as a function of patients seen. Unless they're in a niche subset of medicine (cosmetic surgery) or have their own practice setup (hint: you won't find surgeons buried in school debt operating their own practice; the overhead is insane [staff, material goods, and oh god the insurance] would bankrupt a surgeon straight out of residency/fellowship), they're going to be debtors…

"or have their own practice setup"

No, but they do form "associations". Small practices between 6-10 surgeons to share costs but otherwise be effectively a private practice.

Re: Can Good Doctors Be Bad for Your Health?

#32

Post by doki_pen »

aggieben wrote: post #22

I really wish people would quit treating doctors as unquestionable authorities on health. Rather, they should be treated as consultants - expertise for hire - who should be able to give good answers to most questions, but should expect to have to defend their recommendations, and can sometimes be wrong.

Doctors act like authorities and get upset with patients when they disagree with treatment.

Re: Can Good Doctors Be Bad for Your Health?

#33

Post by iheartmemcache »

FireBeyond wrote: post #31
iheartmemcache wrote: post #23

Earlier quoted context omitted.

Most medical doctors in the US aren't paid as a function of patients seen. Unless they're in a niche subset of medicine (cosmetic surgery) or have their own practice setup (hint: you won't find surgeons buried in school debt operating their own practice; the overhead is insane [staff, material goods, and oh god the insurance] would bankrupt a surgeon straight out of residency/fellowship), they're going to be debtors…

"or have their own practice setup" No, but they do form "associations". Small practices between 6-10 surgeons to share costs but otherwise be effectively a private practice.

Without derailing this discussion, yeah this happens but only at a later stage in your career where you have the 'name recognition' in your subset of surgery so that your colleagues trust you enough you to even bring you in as a partner. I'm limited to the NE region, but I've never once seen a surgeon or medical practitioner form his/her own association or join in as a JP into an already established association until they were well out of the burden of debt.

In the same way that attorneys generally don't go straight into the market and form Johnson, Thompson LLP until they have a few wins under their belt at Skadden or Cravath and a few clients they know they can bring over, your typical niche association won't hire you into their surgical association even with half a decade out with a bunch of articles with you as lead surgeon in high-impact journals. You're still considered a risk as a partner (nepotistic situations notwithstanding).

Re: Can Good Doctors Be Bad for Your Health?

#34

Post by stronglikedan »

moistgorilla wrote: post #20

When I was 19 I was diagnosed with something called hydronephrosis. It's effect on my kidney function wasn't significant but my parents took me to see one of the most famous urologists (I think the hospital was in philadelphia) anyway. I don' remember the specifics but the doctor immediately recommended invasive surgery. My father then took me to another urologist he knew from a friend's recommendation. This doctor s…

Had the same thing happen when I broke my hand. The first doctor wanted to fill it with metal. A second opinion with a more conservative doctor caused me to avoid that surgery, and it healed just fine.

I encountered the same egregious attitude when cancelling the appointment. It made me realize all the more that it was a attempted money grab, with no real concern for my wellbeing.

It was quite the learning experience. I will now never not get a second opinion.

Re: Can Good Doctors Be Bad for Your Health?

#36

Post by maj0rhn »

I'd offer case-mix as a simple explanation of the findings. In other words, when lots of cardiologists in a hospital leave for a conference, elective procedures are deferred until their return... which means that emergency cases constitute a larger proportion of the reduced number of cases that do come into the hospital during the conference. It is completely reasonable to believe that emergency cases have a higher mortality rate than elective cases. This would raise the mortality rate, but not the mortality count. The same effect would probably be seen over long holidays, when people tend not to schedule elective cases.

Re: Can Good Doctors Be Bad for Your Health?

#37

Post by [deleted] »

maj0rhn wrote: post #36

I'd offer case-mix as a simple explanation of the findings. In other words, when lots of cardiologists in a hospital leave for a conference, elective procedures are deferred until their return... which means that emergency cases constitute a larger proportion of the reduced number of cases that do come into the hospital during the conference. It is completely reasonable to believe that emergency cases have a higher m…

[deleted]

Re: Can Good Doctors Be Bad for Your Health?

#38

Post by crpatino »

mamon wrote: post #17
jpmattia wrote: post #7

> Despite often repeating the mantra “First, do no harm,” doctors have difficulty with doing less — even nothing. We find it hard to refrain from trying another drug, blood test, imaging study or surgery. It's disappointing that the conflict-of-interest is not better recognized. Asking a surgeon if you need surgery? Do you really expect a person under a pile of medical-school debt to give you an unbiased answer?

I wouldn't link that to money issue. Rather than that I would say: "When all you have is hammer, everything looks like nail". Surgeons try to solve all the problems, including changing a light-bulb, by surgery, psychiatrists by psychotherapy, traditional Chinese medicine adepts by acupuncture.

Right, which is why the GPs were such an undervalued cornerstone of the old fashioned medical system. They were the ones supposed to hold the big picture in mind, and to cousel their patients when the intervention of an specialist was needed.

Today, they have been turned into glorified technitians and the front end of a pipeline that leads to expensive and potentially unneed treatment. There's no wonder everything turns into hammers and nails when you keep busy your handymans holding the door open.

Re: Can Good Doctors Be Bad for Your Health?

#39

Post by Retric »

wfo wrote: post #15
jpmattia wrote: post #7

> Despite often repeating the mantra “First, do no harm,” doctors have difficulty with doing less — even nothing. We find it hard to refrain from trying another drug, blood test, imaging study or surgery. It's disappointing that the conflict-of-interest is not better recognized. Asking a surgeon if you need surgery? Do you really expect a person under a pile of medical-school debt to give you an unbiased answer?

Yes absolutely. People are capable of looking past economic concerns when the lives of another are at stake and we should absolutely expect them to in this case. What's disappointing is the notion that we've sunk so low in our expectations of humanity that we even assume doctors are constantly calculating min/max selfish economic expectation when they advise their patients. Luckily while some doctors are scam artists…

If A and B are equivalent, and B makes you money, most people have a large unconscious bias to B. Which is perfectly reasonable. The problem is if A is ever so slightly better that bias is still there.

The is directly observed when doctors are for example incentivized or penalized for over prescribing medication. So, no expecting unbiased options it an unreasonable standard.

PS: This is often why second opinions are so valuable. If a doctor has no economic stake in the outcome they often give better advice for the patient.

Re: Can Good Doctors Be Bad for Your Health?

#40

Post by palimpsests »

iheartmemcache wrote: post #26
aggieben wrote: post #22

I really wish people would quit treating doctors as unquestionable authorities on health. Rather, they should be treated as consultants - expertise for hire - who should be able to give good answers to most questions, but should expect to have to defend their recommendations, and can sometimes be wrong.

Medical doctors are like auto-mechanics or, to make a more HN-relatable comparison, software engineers trying to debug a program. Except there's a little more schooling, a lot more rigor with boards examinations, and you don't really have the full source-code available to debug. Just like in any profession, you're going to have crappy auto-mechanics who'll just pull up the ODB-II code and perform patch-work without r…

> a little more schooling

... after getting a bachelor's degree (3-5 years) a general practitioner takes at the bare minimum 7 years of schooling and internship. Surgeon far more than that. One can work as a professional software engineer without ever attending any university.

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